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HomeMy WebLinkAbout29345-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-29618 Date: 08/01/03 THIS CERTIFIES that the building ALTERATION Location of Property: 300 BAY LA ORIENT (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 24 Block 2 Lot 20 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 28, 2003 pursuant to which Building Permit No. 29345-Z dated APRIL 29, 2003 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is BATHROOM ALTERATION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to D CLAEYS BAHRENBURG (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N 576858 11/26/01 PLUMBERS CERTIFICATION DATED N/A AAIkdoiNed Sign ure Rev. 1/81 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 29345 Z Date APRIL 29, 2003 Permission is hereby granted to : D CLAEYS BAHRENBURG 3 EAST 94TH STREET NEW YORK,NY 10128 for BATHROOM ALTERATION AS APPLIED FOR WITH FLOOD PERMIT at premises located at 300 BAY LA ORIENT County Tax Map No. 473889 Section 024 Block 0002 Lot No. 020 pursuant to application dated APRIL 28, 2003 and approved by the Building Inspector to expire on OCTOBER 29, 2004 . Fee $ 250 . 00 uthorized nature COPY Rev . 5/8/02 Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT _ TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and subtrtted to the Building Department with the following: A. For new building or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal (S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy-New dwelling$25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building$25.00, Additions to accessory building$25.00, Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building- $100.00 3. Copy of Certificate of Occupancy-$.25 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy- Residential $15.00, Commercial $15.00 `Jute. 1tz/ � New Construction: Old or Pre-existing Building: ✓ (check one) Location of Property: d ce=te L.t� N --'] (I I 4usse No. Street Hamlet Owner or Owners of Property: 1D . VSAtbeM�i t-- Suffolk County Tax Map No 1000, Section Zl*- Block I— Lot Subdivision Filed Map. Lot: Permit No. 3�J - Date of Permit. Applicant: — Health Dept. Approval: Underwriters Approva : _ Planning Board Approval: Request for: Temporary Certificate Final Certificate: _ (check one) Fee Submitted: $ ((�� a �f�,�fa,Gt l�1 �-g _ p��a fie. 1(,9 G 1 IZ`p App6�iy t j&e P.O. 0k310 Oriva, NY 11957-0310 THE . NEW YORK BOARD OF FIRE UNDERWRITERS 75?-Vj •UREAU OF ELECTRICITY a 40 FULTON STREET,NEW YORK,NY 10098 . Date NPOVE110M 2.i.;�Ge Application No.on file 1.01907`?0 0 5'!-85IR T"IS CERTIFIES THAT d only the sleet ied equipment as described below and introduced by the,applicant=wed on the-above application number is in dw premises of 0 MR `L!iHyx~ D. 8Mr%V_-BhRG, MI 6h�Y c�►l ORIENT, Nei in-the follow location;. Basement Ist FL 2Frd FL T Section Block Lot g8 ATTIC -1C�'I` N was examined on N(YVL`HBER 4W,0 „ , and found to be in complienec with the National Electrical Code. a FIXTURE RECEPTACLES SWITCHES FIXTURES RANGES COOKING DECI6S OVENS , DISH WASHERS EXHAUST FANS OUTLETS FIUORESCENT I OTHER AMI. K.W. AW. K.W. AMF. K.W. AMT. K.W. AMT. N.P. DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECK REC K. TIME CLOCKS SELL UNIT HEATERS MULTI-OUTIET WMNERS SYSTIMIS AMr. iL w. OS: H.P. GAS N.P. AMT. NO. A.W.G. AMT. AMP. AM[. AMPS. TRANS. Ain.I. N.P. NO OF FEET AW. WAIF! ` S i Z01 d M SERVICE DISCONNECT NO. S E R V. I .,r C E 10 - AMT. AMP. tVPE EQUIP. If ZMI f i SW a E sw S R bW NO.of ER GOND. A.W.6. MO.OF 14141% '4 W-GE NO.OF NEUTRALS A.W.G. FEQ OF OC.COND. Of HI-LEG OF NEHTRAI J, 5001W (gyp OTHER APPARATUS: "--o'2 D07F."TOR-1 SEA- I sp. M GF I-11"� F�ti�i�Lli�l� 100T4 TRIKIR� IU,, SW T':}4 i FI:E,'k'SE REMIT BY CHECK (:,F.- �,r<E v oRrEF Tc it�OF;DF�or•r�•_ .- lJ y?r�;.i ! r+ .q "] (YT GRY.ROARD OF FIRE t h'GEF.r:f-.:'+ € !�'�.T��;l,.�,'Jb}..s ;.: �'_ �. 2@0 i,s cr814.SENT OYMAJ:_WILL rE AT Rr.'.h J OF SENDER. Per TtitS IS YOUR BILL FOR SERVICE:RERDERED t M IS RIQT A CERTIFICATE OF COMPLIANCE.THIS BILL P-AY4BLE AT TtiE 14EW YORK OFFICE=.4Q ruLT K,S"ir f,KMI YORK,id.Y-1003E THE NEW YORK BOARD OF FIRE UNDERWRITERS;,, �r 4�:►{ cd BUREAU OF ELECTRICITY 40 FULTON STREET, NEW YORK, NY 10030 e DWe KrVEMME R 2 6 r 20ca1 Application No. on file -1.il%907 3)0C1 j;o N 516 a 58 THIS CERTIFIES THAT only the electrical equipment as described below.and immodaced by the app&d nt named on the above application number iE m the premises of e !fin ft'jAPYS. DEMP-MaN MG. WE` BtNY P Vr,. ORIENT, W in the following location; LJ Basement kJ Ist FL j] 2nd Ft. ATTIC:/z jUT Section Block Lot was examined on NOVE i R. 07 t 20el . and found to be in compliance with Ae National E&c&ical Code. N MURE RECEPTACM SWKIN ITCHES FIXTURES RANGES COOG DECKS OVENS DISH WARM EXHAUST FANS ti OUTLETS FLUO ►+r OT"S '.. AMr. •K.W. AMT. K.W. AMT. K.W. AME K.W. AMT. K.P. 6 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS W MAL MC-PT. TM CLOCKS owl UNIT HEATERS NULTS DIMMERS AMT. r-W. On K.P. GAS I N.P. I AMT. I NO. A.w.6. AMT. AMP. AML AMR. TRANS. AMT. N.P. NO.OF FEET AM- WAM ::..SERVICE QISCONNECf. fw.OF S. ..; Ip AMS. AMP. TYPE EMAP. !R 2W t SW 3 SW s t{1N Of CC GOND. NO-OF Nt-IEC IAF HIS NO.OF WL Wi OF IIEU RY1L_ !n Q1 N OMER APPARATUS: M ifl U - Z (,MOUNT U + R 75 r�_kEE REI:ti:T BY C?;FCt: yP ;d01-1-1 3F,1.. G ,.. t.,z - 'n F Fr � � e QRGEP.TO TI?t:CRC&t�C�5'HC U FCR!:Q.1AFC OF FIRE iit�?��LRYr^i5.. Act C,t,gl=gets-_. ,{:4li WILL :T i;!S' _j F� E TR1:C INC. LI`C.# 3823. �cis SEIJoeR. J W .�1. 5 £ d LAUREL, NY, 1.:1.948...0518 Per xi THIS IS YOUR BILL FOR SERVICE RENDERED AND IS NOT A CERTIFICATE OF COMPLIA M THIS BILL PAYAMX-AT 714E MW YORK OMICE,40 FULTON ETPM,,WELM YORK:iV.Y.100 .- ' • Jl4j�'<1'H T. TERRY ( �`. .: .`� Tn...n H:dl. 51l1yS Mam Rn TOWN CLERK 'r'^' o '•. R - /.� P.O. floc 1179 I � Suullpild. Nc'c lurk I Itl7 ((EGISFRAR OF VITA.SFATIS"IICS (G3 `- .^� • Fax (.51 of 7h�_ 1911 MARRIAGE OFFICI'R _ J O� Tclt phnnt ISI(.I 7(,5 1 X()1 RECORDS MANAGEMENT 01-FICEIi '/OI FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION WAS ADOPTED BY THE SOUTHOLD TOWN BOARD AT A REGULAR MEETING HELD ON AUGUST 24, 1993 : RESOLVED that the Town Board of the Town of Southold hereby adopts two (2) new forms to be used under the Flood Damage Prevent regulations of the Code of the Town of Southold: "Floodplain Development Permit Application" (FDP(93) ] , and "Certificate of Compliance for Development in Special Flood Hazard Area (C/C(93) ) . TOWN OF SOUTs HOLD � T � Southold Town Clerk August 25, 1993 ' APPLICATION a PAGE I of a TOWN OF SOUTHOLD FLOODPLAIN DEVELOPMENT PERMIT APPLICATION This form is to be filled out in duplicate. SECTION 1• GENERAL. PROVISIONS (APPLICANT Io read and sitml: 1. No work may start until a permit is issued. 2 The permit may be revoked if any false statements are made herein. 3. If revoked, all work must cease until permit is re-issued. 4. Development shall not be used or occupied until a Certificate of Compliance is issued. 5. The permit will expire if no work is commenced within six months of issuance. 6. Applicant is hereby informed that other permits may be required to fulfill local, state and federal regulatory requirements. 7. Applicant hereby gives consent to the Local Administrator or his/her representadve to make reasonable inspections required to verify compliance. 8. I, THE APPLICANT,CERTIFY THAT ALL STATEMENTS HEREIN AND IN ATTACHMENTS TO THIS APPLICATION ARE,TO TJ BEST OF <NO0 VLEDGE,TRUE AND ACCURATE. (APPLICANTS SIGNATURE) w DATE 03 SECTION 2• PROPOSED DEVELOPMENT (To be completed by APPLICANM NAME ADDRESS TELEPHONE APPLICANT ENGIROER PROJECT LOCATION To avoid delay in processing the application, please provide enough information to easily identify the project location. Provide the street address, lot number or legal description (attach) and, outside urban areas, the distance to the nearest intersecting road or well-known landmark A sketch attached to this application showing the project Io tion would be helpful. - FDP(93) APPLICATION _ PAGE 2 OF a DESCRIPTION OF WORK (Check all appbcable boxes) A. STRUCTURAL DEVELOPMENT ACTIVITY STRUCTURE TYPI- ❑ New Structnrc O Residential (1-4 Family) ❑ Addition ❑ Residential (More than 4 Family) ❑ Alteration ❑ Noo-residenual (Floodproofmg? O Yes) ❑ Relocation ❑ Combined Use (Residential & Commcrdal) ❑ Demolition r ❑ Manufactured (Mobile) Home (In Manu- ❑ Replacement factured Home Park? ❑ Yes) ESTIMATED COST OF PROJECT S B. OTHER DEVELOPMENT ACTIVITIES: ❑ Fill O Mining 0 Drilling ❑ Grading ❑ Excavation (Except for Structural Development Checked Above) ❑ Watercourse Alteration (Including Dredging and Channel Modifications) O Drainage Improvements (Including Culvert Work) ❑ Road, Street or Bridge Construction O Subdivision (New or Expansion) ❑ Individual Water or Sewer System ❑ Other (Please Specify) After completing SECTION 2, APPLICANT should submit form to Local Administrator for rcview. SECTION 3: FLOODPLAIN DETERMINATION (To be cornRlctcd by LOCAL ADMINISTRATOR) The proposed development L located on FIRM Panel No. . Dated The Proposed Development: O IslM located in a Special Flood Hazard Area (Notify the applicant that the applicatiou review is complete and NO FLOODPLAIN DEVELOPMENT PERMIT IS REQUIRED). ❑ Is located is a Special Flood Hazard Area. FIRM zone designation is 100-Year flood elevation at the site is: Ft. NGVD (MSL) ❑ Uuavailablc ❑ The proposed devdopmenl is located in a floodway. FBFM Panel No. Dated a Scc Scction 4 for additional instructions SIGNED DATE .r • APPLICATION a PAGE 3 OF 4 SECTION 4' ADDITIONAL INFORMATION REQUIRED (To he comnlctcd by LOCAL ADMINISTRATOR) The applicant must submit the documents checked below before the application can be processed: Cl A site plan showing the location of all existing structures, water bodies, adjacent roads, lot dimensions and proposed development. ❑ Development plans, drawn to scale, and specifications, including where appficablc:details for anchoring structures, proposed elevation of lowest floor (including basemenQ, types of water resistant materials used below the first floor, details of floodproofmg of utilities located below the fust floor and details of enclosures below the fust floor. Also O Subdivision or other development plans (If the subdivision or other development exceeds 50 lots or 5 acres,whichever is the lesser, the applicant must provide 100-ycar flood elevations if they are not otherwise available). ❑ Plans showing the extent of watercourse relocation and/or landform alterations. ❑ Top of new fill elevation R. NGVD (MSL). S ❑ Floodproofng protection level (non-residential only) Ft, NGVD (MSL). For floodproofed structures, applicant must attach certification from registered engineer or - architect. ❑ Certification from a registered engineer that the proposed activity in a regulatory floodway will not result in any increase in the height of the 100-year flood. A copy of all data and calculations supporting this funding must also be submitted. ❑ Other: SECTION 5• PERMIT DETERMINATION (To be completed by LOCAL ADMINISTRATOR) I have determined that the proposed activity. A. O Is B. O Is not in conformance with provisions of Local Law if_, 19_. Tho permit is issued subject to the conditions attached to and made part of this permit SIGI,ED , DATE If BOX A is checked, the Local Administrator may issue a Development Permit upon payment Of designated fee. If BOX B is checked, the Local Administrator will provide a written summary of deficiencies. Applicant may revise and resubmit an application to the Local Administrator or may request a hearing from the Board of Appeals. APPLICATION a _ PAGE a OF a APPEALS: Appealed to Board of Appeals? ❑ Yes O No Hearing dale: Appeals Board Dcusio❑ --- Approved? ❑ Yes O No Conditions SECTION G: AS-BCJILT ELEVATION4 (To be submitted by APPLICANT before Certificate of Compliance is issued The following information must be provided for project structures. This section must be completed by a registered professional eogmeer or a licensed land surveyor (or attach a certification to this application). Complete 1 or 2 below. 1. Actual (As-Built) Elevation of the top of the lowest floor, including basement (n Coastal High Hazard Areas bottom of lowest structural member of the lowest floor, excluding piling and columns) is: Fr. NGVD (MSL). 2 Actual (As-Built) Elevation of floodproofng protection is FT. NGVD (MSL). NOTE: Any work performed prior to submittal of the above information is at the risk of the Applicant. SEMON 7" COMPLGLNCE ACTION (To be comnleted by LOCAL ADMINISTRATOR) The LOCAL ADA11NISTRATOR will complete this section as applicable based on inspection of the project to ensure compliance with the community's local law for flood damage prevention. INSPECTIONS: DATE BY DEFICIENCIES? ❑ YES ❑ NO DATE BY DEFICIENCIES? ❑ YES ❑ NO DATE BY DEFICIENCIES? ❑ YES ❑ NO SEC11ON 8: CERTIFICATE OF OMPLIANCE(To be completed by LOCAL ADMINISTRATOR) Certificate of Compliance issued: DATE BY: Attachment B SAMPLE CERTIFICATE OF COMPLIANCE for Development in a Special Flood Hazard Area n TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE FOR DEVELOPMENT IN A SPECIAL FLOOD HAZARD AREA (OWNER MUST RETAIN THIS CERTIFICATE) PREMISES LOCATED AT: PERMIT NO. PERMIT DATE OWNERS NAME AND ADDRESS: CHECK ONE: ❑ NEW BUILDING ❑EXISTING BUILDING O VACANT LAND THE LOCAL ADMINISTRATOR IS TO COMPLETE A. OR B. BELOW: A. COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF - LOCAL LAW #_, 19 SIGNED: DATED: B. COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW # 19AS MODIFIED BY VARIANCE # DATED SIGNED: DATED: C/C (93 ) M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ FINAL [ ] FIREPLACES CHIMNEY REMARKS: 92!1� •�•.- O� iv G? o DATE INSPECTOR FL LD INSPECTION REPORT DATE cobo E m FOUNDATION(1ST) -------------------- ---- C C21 FOUNDATION(2ND) z 0 _ o y ROUGH FRAMING& PLUMBING INSULATION PER N.Y. STATE ENERGY CODE O 64. FINAL ADDITIONAL COMMENTS O h z. m o 0 z d TOWN OF SOUT14DLD10� BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the follovang,before applying'? TOWN HALL Board of Health SOUTHOLD, NY 11971 3 sets of Building Plans TEL: (631) 765-1802 Planning Board approval FAX: (631) 765-9502 2ct � Survey— www. urveywww. northfork.net/Southold/ PERMIT NO. / Check Septic Form N.Y.S.D.E.C. ExaminedY Z 20 -3 Contact:Trustees Approved 20 Mail to: Disapproved a/c 01 Phone:_ Expiration ,20� - -. Building Insp ctor Hr� 2 3 M3 APPLICATION FOR BUILDING PERMIT Date Wv0 INSTRUCTIONS _1 a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and waterways. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such a permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy. f Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the property have been enacted in the interim,the Building Inspector may authorize, in writing,the extension of the permit for an addition six months. Thereafter, a new permit shall be required. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County,New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions, or alterations or for removal or demolition as herein described. The applicant agrees to comply with all applicable laws, ordinances,building code,housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. Signature of applicant or ,-if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on which proposed work will be done: 300 6'5� Ai- � 0F14F;KJ'- House Number Street Hamlet County Tax Map No. 1000 Section 7,+— Block '` Lot., Subdivision Filed Map'No. Lot (Name) y 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy 1 _,. t(�F� l[ ►P3Cp � >� b. Intended use and occupancyjrrl n[Ffz1,Ll � tf�� 3. Nature of work (check which applicable): New Building Addition Alteration Repair Removal •'(Z{fl Demolition Other Work (Description) 4. Estimated Cost �d00 •� Fee (To be paid on filing this application) 5. If dwelling, number of dwelling units Number of dwelling units on each floor If garage, number of cars 2� neoTC6 eo 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front 5-1 2 (AhAcar 3Z t•>LAt Depth -77• N& . Height V-2-5" AAA-%I Number of Stories S-- Dimensions iDimensions of same structure with alterations or additions: Front 5`� 'Z AA.Atl Real-3-7 AtfF�. Depth :11' M ASC Height Z? •S' iAcX Number of Stories. 'L 8. Dimensions of entire new construction: Front &IpEk� Rearhtls-j- Depth A4U4"6 Height Number of Stories 9. Size of lot: Front a1 t JAAjL Rear -7 Z A40 • Depth 2,6 4-• M h-4 10. Date of Purchase 414- ['10 Name of Former OwneLP 11. Zone or use district in which premises are situated / 12. Does proposed construction violate any zoning law, ordinance or regulation? YES_NO�v 13. Will lot be re-graded? YES_NO—Will excess fill be removed from premises?YES;NO -2. CfA'15Y3 3 F .`�Mr~t 5T-, 14. Names of Owner of premises Address mi C O tvg Phone No�Z Name of*mbitcnt (�J —o ddress f30"S'- -Phone No 26-O e: G Name of Contractor Address Phone No. 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. In. Is this property within 300 feet of a tidal wetland? * YES NO * IF YES, D.E.C. PERMITS MAY BE REQUIRED. 16. Provide survey, to scale, with accurate foundation plan and distances to property lines. 17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey. STATE OF NEW YORK) SS: COUNT--Y OF �� (ter being duly swom, deposes and says that (s)he is the applicant G,Irimc of individual signing contract) above named, (S)He is the (Contractor, Agent, Corporate Officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. to before me this AV ~� av of Y rl � L � otary Public Signature of pplicant NOTARY PUBLIC, tattee of New York No. 01806020932 Ouslified in Suffolk Tam Expires March 8,20� ALL CONSTRUCTION SHALLkrlHE — IIIIEET THEM r' h' — — — — — —j —— — AWVW CODES OF NEW YORK ST T I � RATE: Z� B.P. 3 I I M EE: v BY: CITIFY BUILDING DEP TMENT AT PL U CERTI T N I L IS•1SM SAM TO 4P FOR THE TENT E RE FOUNDATIONiWTo R 7E OF PNC I I -,r r. FOR POURED CONCR SOLDE USED i A R ROUGH - FRAMING 3 UMBING SUPPL T � 7�y �lNil ��hI EXCEED 2/10 OF L � Yrn; t. BE COMPLETE FOR3 :1 LL 9ONSTRUCTION sH MEET THE PLUMBIN i Tlk'r It TA 1� EOUIREMENTS OFT E DRK STATE. NOT R I YYI G if?PlT'�t s=�ci_ ESIGN OR CONSTR T TING BEFORE CO R NG I I i nn�I1D 4 UrNiLmvvr-%L � ri WITHOUT CERTIFICATE -° - 7A- APR 2 92003 �fNOyA�'tOH• -TAP ,l�f OF OCCUPANCY T.� MUMMERS NL i QUIRED t , RE - 'LOODZONE °� -- - - 1 Y �OMPLY WITH CHAPTER" 18� 5 1 LOOD DAMAGE PRE TION ;d. ©32z54.1 wr oLITHOLD TOWN DE. � , ( u pF ------ -- — — — — — — — b -- zq T -7 'V L2 �j F - - - - }